Lost-Time Workers' Comp Claims Adjuster

The James Allen Companies, Inc; South Carolina; Sur place; USD 55 000 - 85 000; Plein temps

Résumé du poste

The James Allen Companies, Inc. is seeking an experienced Workers’ Compensation Claims Adjuster to manage a caseload of lost time claims in South Carolina.

You will handle the full life cycle from initial report through resolution, including investigations, reserving, medical management, and negotiations. The ideal candidate has at least two years of workers’ compensation claims handling, SC Adjuster license, and strong investigation, negotiation, and documentation skills.

Qualifications

• Minimum of two years of workers’ compensation claims handling experience.
• South Carolina Workers’ Compensation Adjuster License required.
• Bachelor’s degree preferred but not required.
• AIC or similar insurance designation preferred.
• Strong investigation, reserving, negotiation, and claims management skills.
• Ability to exercise independent judgment when making claims decisions.
• Knowledge of workers’ compensation statutes, regulations, and compliance requirements.
• Ability to manage medical, legal, and vendor relationships.
• Strong organizational, communication, and documentation skills.

Responsabilités

• Manage lost time workers’ compensation claims from initial report through resolution.
• Conduct thorough claim investigations and make compensability determinations.
• Establish and maintain appropriate claim reserves.
• Manage indemnity and medical payments on assigned claims.
• Monitor medical treatment, return-to-work efforts, and overall claim development.
• Ensure CMS Section 111 requirements are properly applied and reported through the designated vendor.
• Coordinate with attorneys, medical providers, nurse case managers, investigators, surveillance vendors, independent medical examination providers, and other claim-related vendors.
• Manage litigated claims and work closely with defense counsel to develop appropriate claim strategies.
• Attend mediations, informal conferences, hearings, and other claim-related proceedings as necessary.
• Evaluate claims for settlement opportunities and negotiate resolutions when appropriate.
• Monitor claim exposure and refer claims exceeding or reasonably expected to exceed $200,000 to the appropriate senior claims professional.

Connaissances

Workers’ compensation claims handling

Investigation skills

Negotiation skills

Claims management

Communication skills

Documentation skills

Independent judgment

Formation

South Carolina Adjuster License

Bachelor’s degree preferred

AIC designation preferred

Description du poste

The James Allen Companies, Inc. is seeking an experienced Workers’ Compensation Claims Adjuster to manage a caseload of lost time claims in South Carolina.

You will handle the full life cycle from initial report through resolution, including investigations, reserving, medical management, and negotiations. The ideal candidate has at least two years of workers’ compensation claims handling, SC Adjuster license, and strong investigation, negotiation, and documentation skills.